The problem of nonmedical exemptions from school vaccine mandates is getting worse

It’s feast or famine in the ol’ blogging world, and right now it’s such a feast that I can’t decide what to blog about. For instance, there are at least two studies and a letter that I wouldn’t mind blogging about just in the latest issue of the New England Journal of Medicine alone. Then there’s SaneVax and Dr. Sin Hang Lee, who has apparently released another study again claiming that the anti-HPV vaccine Gardasil is contaminated with—horror of horrors!—DNA. A quick perusal of it tells me that it’s probably the same principle of PCR that I’ve discussed before, namely that it’s quite possible to amplify almost anything even if the target sequence isn’t there if you use methods that are too permissive and run enough cycles. Maybe I’ll take it on next week, because it’s one of those things that antivaccinationists are quoting and thus needs a rebuttal for the record. I’m just the guy to do it, too. Then there are a couple of other studies that have been floating around out there that I’d like to blog. It’s unlikely that I’ll get to them all in a timely fashion. No doubt the next time there isn’t much going on that interests me I’ll long for days like this.

In the meantime, though, let’s talk about vaccine exemptions. I’m on one of my periodic rolls blogging about vaccines anyway; so it’s time to go all in, particularly since apparently Anne Dachel and her fellow antivaccine propagandists from that most wretched of wretched hives of scum and antivaccine quackery of which she is the Media Director, Age of Autism, have moved on from the news story I mentioned yesterday and have swarmed over to the New York Times to infest the comments of a different news story telling actual good news for a chance about vaccines, Washington State Makes It Harder to Opt Out of Immunizations:

Washington State is home to Bill and Melinda Gates, champions of childhood vaccines across the globe. Its university boasts cutting-edge vaccine research. But when it comes to getting children immunized, until recently, the state was dead last.

“You think we’re a cut above the rest,” said Dr. Maxine Hayes, state health officer for Washington’s Department of Health, “but there’s something in this culture out West. It’s a sort of defiance. A distrust of the government.”

The share of kindergartners whose parents opted out of state immunization requirements more than doubled in the decade that ended in 2008, peaking at 7.6 percent in the 2008-9 school year, according to the state’s Health Department, raising alarm among public health experts. But last year, the Legislature adopted a law that makes it harder for parents to avoid getting their children vaccinated, by requiring them to get a doctor’s signature if they wish to do so. Since then, the opt-out rate has fallen fast, by a quarter, setting an example for other states with easy policies.

Good going, Washington! It’s about time. Over the last several years, Washington has become known as a state with such low vaccine uptake rates that it was fast on its way to becoming the capital of vaccine-preventable diseases; that is, if it could beat California, which is currently considering its own similar bill (AB 2109) that would require a doctor’s signature on vaccine exemptions certifying that the parents have been counseled and given true informed consent about the risks of not vaccinating. (This is, of course, in contrast to the misinformed consent, in which vaccines are blamed for autism, asthma, autoimmune diseases, sudden infant death syndrome, and more by antivaccinationists in order to provide a false picture of the balance of risks and benefits of vaccines that make vaccines look like the riskiest thing you can do to your child. Such are the lies of the antivaccine movement.) Indeed, Rob Schneider, of all people, has arisen as a new celebrity leader of the antivaccine resistance to AB 2109 on par with the idiocy of Jenny McCarthy on vaccines, even going so far as to claim vaccines are a violation of the Nuremberg Code.

In the U.S., certain vaccines are required before children can enter school, and there is a wide range of how tightly these vaccine mandates are enforced. In two states (West Virginia and Mississippi), for instance, no non-medical exemptions are permitted; i.e., only children with legitimate medical reasons can be exempted from vaccines. The other 48 states allow some form of non-medical exemptions to vaccine mandates. Twenty of these states allow “philosphical” or “personal belief” exemptions.

Non-medical exemptions are a delicate topic. On the one hand, there s overwhelming evidence that such exemptions lead to more children remaining unvaccinated, more children at risk for potentially deadly vaccine-preventable diseases, thus degrading herd immunity and contributing to outbreaks. In the U.K., the MMR scare has been particularly devastating, leading to a massive resurgence of the measles over the last 14 years, as MMR uptake fell to as low as 50% in some parts of London. On the other hand, in the U.S. in particular, there is very much a strain of extreme resistance to being told what to do by the government. We’re actually seeing that in play right now, as I believe that much of the resistance to the Patient Protection and Affordable Care Act (colloquially known as “Obamacare”) derives from just that resistance. In the case of vaccine exemptions,

An increasing number of parents are getting state approval to allow their children to opt out of school-mandated vaccinations for non-medical reasons, according to a new analysis published Wednesday.

Dr. Saad Omer, author of the correspondence published in the New England Journal of Medicine, warned that this trend is leaving large populations of children at risk for developing potentially deadly illnesses that haven’t been seen in the United States in many years.

“Rates of exemption are substantially higher today than several years ago,” said Omer, assistant professor of global health, epidemiology and pediatrics at Emory University in Atlanta. “Previously, rates were only rising in states with easy exemption policies, but now they are even rising in states that make it more difficult.”

Basically, what Omer et al found is what I like to call a “Well, duh!” result, but sometimes “Well, duh!” results are important. In this case, Omer’s results were not the least bit unexpected, but the reason for him to do the study is (1) to determine whether “common wisdom” about vaccine exemptions is correct (it turns out that it is) and (2) to quantify the effect, which is what Omer et al tried to do. Common sense and an understanding of human nature tell us that if something’s easy to get more people will take it and that if something’s harder to get fewer people will take it.

What Omer et al found is that during the study period, nonmedical vaccine exemptions were 2.54 times as high in states that allowed philosophical exemptions as they were in states that allowed only religious exemptions. Omer et al then categorized states allowing nonmedical exemptions by the degree of difficulty in obtaining such exemptions. Categories of difficulty were based on several factors, including whether completion of a standard form was permissible, as opposed to a letter; where the parent has to get the form (school versus health department); whether the form needed to be notarized; whether a physician needs to sign it; and the like. The results were, as I pointed out, predictable:

During the study period, unadjusted rates of nonmedical exemptions in states with easy exemption policies were 2.31 times as high as rates in states with difficult exemption policies (IRR, 2.31; 95% CI, 1.39 to 3.85). By 2011, the nonmedical exemption rate in states with easy exemption criteria increased to 3.3%, an average annual increase of 13% (IRR for change per year, 1.13; 95% CI, 1.05 to 1.21) (Figure 1, and Table S1 in the Supplementary Appendix). In contrast, nonmedical exemption rates in states with difficult exemption criteria increased by 8% annually to 1.3% in 2011 (IRR for change per year, 1.08; 95% CI, 1.02 to 1.14). In states with exemption criteria of medium difficulty, rates increased by 18% annually to 2.0% in 2011 (IRR for change per year, 1.18; 95% CI, 1.10 to 1.26). For all analyses, adjusted results were qualitatively similar to unadjusted results.

In other words, as one would expect, the easier it is to get nonmedical exemptions from school vaccine mandates, the more parents there will be who will take them. Worse, the authors cited their previous work that examined exemptions from 1991 to 2004, in which they found an increase in nonmedical exemptions only in states where philosophical exemptions were permitted. Comparing their previous results to their current results, Omer et al found a troubling trend, namely that even in the states with philosophical exemptions, the rate of increase in nonmedical exemptions was less than it was from 2005 to 2011. The rate of increase of nonmedical exemptions appears to be accelerating and spreading even to states with only religious exemptions. There are potentially horrific consequences if this trend continues unabated. There is, after all, evidence that lax exemptions policies correlate with a higher incidence of pertussis and measles.

So what is the answer? From a strictly scientific standpoint, the answer is easy. Get rid of nonmedical exemptions. However, this is a situation where the ideal could well be the enemy of the possible. On a strictly political basis, even a lot of people who accept that vaccines are safe and effective and know that the only thing nonmedical exemptions achieve is to degrade herd immunity and increase the likelihood of outbreaks of vaccine-preventable diseases have a bit of a problem with mandates that don’t allow for religious and/or philosophical nonmedical exemptions. In a nation in which the elimination of all nonmedical exemptions to school vaccine mandates will not be possible for the foreseeable future, the next best thing is to make exemptions harder to get. However, even this tactic can run into thorny issues, particularly religious exemptions, if the state tries to make sincerity of belief a criterion. Personally, I reluctantly accept that eliminating nonmedical exemptions is politically toxic. Recent experience in Vermont, California, and even Washington tell us this. Indeed, in California, an unholy alliance of antivaccinationists and Tea Party activists put up a strong fight against AB 2109, which only sought to make it harder to obtain nonmedical exemptions. Indeed, right now, although AB 2109 has passed both houses of the California legislature and is awaiting the governor’s signature, Governor Jerry Brown has not signed it and might not sign it. Meanwhile, antivaccine loons are flooding the governor’s office with demands that he veto the bill. In such a climate, tightening up the process for obtaining nonmedical exemptions is at this time probably the best that we can do, and we might not even be able to accomplish that.

Unfortunately, the antivaccine movement has been very successful in framing the issue of nonmedical exemptions to vaccine mandates not as an issue of medicine and protecting children, but rather as an issue of parental rights, in which an overweening state is portrayed as overstepping its power, crushing the rights of parents, and forcing children to be vaccinated. Perhaps that’s one reason why antivaccine views tend to appeal to Tea Party activists as much as they do to crunchy, pharma-hating people at the opposite end of the political spectrum. Amusingly (well, sometimes anyway), antivaccine activists will even co-opt the political language of the election, as when Barbara Loe Fisher actually had the temerity to claim that those promoting tightening up or eliminating nonmedical exemptions based on personal belief are “waging class warfare.” I kid you not. To Fisher, it’s class warfare against the well-off:

A hilarious exerpt:

It is getting uglier and uglier out there, as angry, frustrated doctors inside and outside of government work overtime to foster fear and hatred of parents making conscious vaccine choices for their children. The latest political dirty trick is to brand parents, who send their children to private schools, as selfish and a threat to their communities because some private schools have higher vaccine exemption rates.

It is, of course, true that many private schools have higher vaccine exemption rates. Waldorf schools come to mind, given that the entire philosophy upon which they are founded includes a medical philosophy that explicitly rejects vaccines. It is also true that many antivaccine parents are well-off and highly educated. It is, as I’ve pointed out before, the arrogance of ignorance, and their higher level of education makes them better at motivated reasoning, resulting in what is sometimes called the “smart idiot” effect. Apparently, to Fisher, pointing that out is “class warfare”:

When doctors politicize vaccine exemptions in order to engage in class warfare, they are crossing a line that reveals more about who they are than the families they are trying to stereotype and marginalize. Dr. Pan, who has assumed the mantle of lawmaker, and Dr. Omer, who enjoys six federal vaccine research grants funded by the CDC or NIH, [12] and Dr. Halsey, who has funding from SmithKline Beecham and the Gates foundation,[13] likely are not struggling to pay the rent or pay for groceries.

Ah, yes. The pharma shill gambit coupled with specious accusations of class warfare. Fisher is nothing if not consistent.

Finally, it’s impossible for me to discuss this issue without addressing the elephant in the room, and that’s religious exemptions. In the states that allow only religious exemptions, religion is being privileged above all other belief systems in being the only legally acceptable basis for parents to opt out of vaccine mandates. That’s why I’m of the opinion (which has on occasion gotten me into little tiffs with fellow travelers in the battle against antivaccine lunacy) that, if a state is going to permit nonmedical vaccines, it should allow both religious and philosphical exemptions. To do otherwise is to give undue privilege to religious belief over nonreligious belief and discriminates against nonbelievers. Antivaccinationists take advantage of religious exemptions anyway, promoting them and even telling parents how to lie about their religious beliefs in states that only allow religious exemptions. So, if a state is going to allow nonmedical exemptions, it should allow personal belief exemptions for any reason or not allow them at all (preferably not at all). In this political climate, probably the best we can hope for is to limit nonmedical exemptions and make them harder to get, which is why I tend to think trying to eliminate them altogether is probably a lost cause that takes up energy that could be better used for other aspects of what is necessary to promote vaccine science. It’s true that overall the national vaccine uptake rate is high and nonmedical exemption rate low, but that’s changing. The increase in nonmedical exemptions is concerning, and in some areas it’s leading to pockets of vaccine resistance such as Vashon Island in Washington, where the exemption rate approaches 25%.

In the meantime, laws should be passed that make nonmedical exemptions rare by requiring parents to do more than just sign a form. It is a battle that was recently won in Washington and California, which leaves only 48 states to go.

115 Comments

If you could do (below) this sooner rather than later it’d be good. It’d nice to have material out before the coroner’s report is released, which shouldn’t be too far away.

re: “Then there’s SaneVax and Dr. Sin Hang Lee, who has apparently released another study again claiming that the anti-HPV vaccine Gardasil is contaminated with—horror of horrors!—DNA. A quick perusal of it tells me that it’s probably the same principle of PCR that I’ve discussed before, namely that it’s quite possible to amplify almost anything even if the target sequence isn’t there if you use methods that are too permissive and run enough cycles. Maybe I’ll take it on next week, because it’s one of those things that antivaccinationists are quoting and thus needs a rebuttal for the record. I’m just the guy to do it, too.”

As for “right now it’s such a feast that I can’t decide what to blog about” I’m feel stuck in the same boat, but over science articles what with still not having written about ENCODE and a raft of other things.

In passing, I will note that there does not seem to have been any Götterdämmerung associated with Washington’s effort, which was signed into law last year. (And I like the cut of Seattle Mama Doc’s jib.)

The only exemption the school should offer is to exempt the child from attending altogether. That child is putting other children at risk if he / she is not vaccinated for childhood diseases and has no sound medical reason for not having been so.

I wonder if these schools outright ban peanut butter, knives or other potentially dangerous items. Because it would be ever so slightly hypocritical and mind boggling if they ban one vector for harm to students while allow others to pass in and out without any objection.

It should only take a few outbreaks in public schools to get the exemption rates back down – as soon as parents realize that their kids are either going to be sick and home for weeks or kept out of school for weeks (and trust me, child care is neither cheap nor easily found nowadays), they’ll realize the error of their ways.

What I also don’t understand, if they are scared of autism – don’t they realize that if a 4 or 5 year old hasn’t been diagnosed yet & is perfectly fine, that getting them up to date with their vaccines isn’t going to “magically” sudden give them the autism?

These people have no common sense. But again, we’ll see how the deal with quarantine from school….since most families are two-parent income, this will hit them right in the pocketbook – and that’s what ultimately will change their minds (if nothing else does first).

I would propose that religious exemptions be eliminated entirely and just have a philosophical which would cover both. Add to this a cap on how many exemptions could be allowed for any school. Another suggestion would be to allow for selective vaccination which a number of vaccine exemptors do. In other words, don’t have exemptions all or nothing, track vaccine rates more accurately and adjust the cap based upon actual vaccine uptake and not merely exemptions. I don’t believe that non-medical exemptions should be eliminated entirely but they need to be managed with choice and public health in mind.

What would you do if your school building has any medically fragile students? Do a daily intake exam by the school nurse for any under vaccinated students – and send them home if they have any symptoms?

“Your child has a slight fever, we are sending them home and they may not return for 24 hours.”.

You’d probably have to have medical isolation rooms to keep potentially ill students until they are taken home. Can’t let them mingle with the general population.

I have mentioned it before on this blog, but it bears repeating any time this topic (exempting one’s children from vaccination as an extension of self-styled “parental rights”) comes up.

That is, parents exercising their autonomy in this fashion are IMO at risk of violating the rights to person of their own children and of other children.

Children are not parents’ playthings. They are fully-fledged citizens who have temporarily-restricted autonomy while they are legally incapable of fully exercising it.

During this phase, parents’ responsibility is to look out for their children’s best interests, interests which ought not to be determined solely by parental whim (though sadly they often are).

We already have sanctions against parents who fail to look out for their children’s best interests via negligence. Even if it can’t be legally enforced I do think that at the very least there should be social reinforcement that (a) failing to vaccinate your children is failing to uphold their best interests, and thus (b) it is negligent.

What would you do if your school building has any medically fragile students? Do a daily intake exam by the school nurse for any under vaccinated students – and send them home if they have any symptoms?

“Your child has a slight fever, we are sending them home and they may not return for 24 hours.”.

Well, I think some orthodox Christians, who think anything that shows any distrust in the almighty god, those who for the same reason reject any insurance, have a policy against vaccines, because it shows you don’t trust in god.
You can find them in the Netherlands, in the so-called bible-belt.

Adam @0447: Exemptions for valid medical reasons are appropriate. Neither the child nor the parents can do anything about the underlying medical condition, so excluding children who have valid medical reasons for not being vaccinated would be discriminatory and quite possibly illegal under the ADA (IANAL).

Washington state has had pertussis outbreaks in public schools. That may be one thing that, as Lawrence @0559 suggested, makes it politically easier to clamp down on philosophical objections.

Our old friend, Louise Kuo Habakus, has been out and about recently, heading off similar legislation: there are articles linking to this @ AoA’s right column and she has appeared on Gary Null’s internet radio show. She heads two anti-vax groups : NJCVC and CPR; in addition, she has pastiched together her mis-information in a book with Mary Holland.

Louise announced a few months ago that she was appointed as PR or media at Focus Autism- a non-profit foundation/ partially woo-ish ( Barry Seagal) but a search yesterday no longer shows her association. Her linked-in lists her business as “financial”.The MA that ostentatiously decorates her publicity has nothing to do with science, medicine or education.

Louise lives across the street from a well-known rock musician and has used this proximity to taunt his guests with signs about vaccinations when he hosted a political event.

In the very late 1970s and early 1980s, my friend, an artist, used to travel all over ( the Middle East, India, the Andes, Central America) to photograph people producing native crafts and folk art: she got the appropriate vaccines but contracted *other* ( primarily amoebic) illnesses endemic in those areas. I was always invited along but never went- and it wasn’t entirely due to my other responsibilities- I really didn’t want to get sick- especially malaria: I’m sure I’d get it as bugs really love to bite me. I clearly remember the maps and information she used to consult before a trip.

I’ve done a great deal of travelling on my own but very little has been in the so-called Third World ( although I’ve seen rather horrible poverty and misery). According to the above information, places like California, Washington and London may now become ‘areas of concern’; maybe we need to think about pertussis and other VPDs that we formerly ignored: I got a flu shot yesterday and actually asked about one for pertussis.

Hi everybody, you are welcome come to Sacramento on 9/28, when there’s an anti-AB2109 rally scheduled at the capitol building. Counter signs would be welcome.

Science Mom wrote

Another suggestion would be to allow for selective vaccination which a number of vaccine exemptors do.

California now publishes data on school-required immunizations in a spreadsheet. (That’s how the AP determined that private schools have higher exemption rates. ) The spreadsheet includes the number and % of students who are up-to-date on each of the required vax (4 Dtap, 3 Polio, 1 or 2 MMR, 3 HepB, 1 Var).

Just by eyeballing the data, it appears there are a lot of partial vaccinators, and the HepB is the one most likely to be incomplete. In other words, it seems there are a fair number of kids who have been immunized against diphtheria, tetanus, pertussis, measles, mumps, and rubella, but not HepB and some cases, polio. I haven’t really looked at varicella.

Just by eyeballing the data, it appears there are a lot of partial vaccinators, and the HepB is the one most likely to be incomplete. In other words, it seems there are a fair number of kids who have been immunized against diphtheria, tetanus, pertussis, measles, mumps, and rubella, but not HepB and some cases, polio. I haven’t really looked at varicella.

Thanks for the info Liz and send me a link if you can please? I knew that some states do track according to vaccine uptake and not just exemptions being “all or not” so my proposal is very do-able with those computer thingys and all.

Aside from Christian Scientists (an oxymoron if there ever was one), what religions object to vaccinations?

From the standpoint of religious exemptions, this not only doesn’t matter, it cannot matter in the U.S. without running afoul of the Constitution. This is how Arkansas got to where it currently is (briefly reviewed from a public health policy perspective here).

I took a peek at Narad’s link ( Seattle Mama Doc) and note that the map @ top left shows 5%-10+% exemption rates around the Sound ( a few other places too).. oh boy! That is near someone who posts here ( you know who you are)
.. I suppose that woo-topia has central loci: the other is probably near Sebastopol ( you-know-who’s stomping grounds). You’d think that someone listed @ Whale and the Alien Enforcer of the Not-so-Free World, would have a bigger influence in their own backyards.

It’s only when you get to fringe religions, like the Church of Illumination, where you get more specific anti-vaccine doctrines. (Although they do not have that listed on their web site, I did shoot them an email to inquire about their position. They were very eager to sell a religious exemption letter to me for a “recommended donation” of $25. They also gave me some Bible passages they interpret as prohibiting vaccines.)

Todd, what verses did they cherry-pick and decontextualize? Off the top of my head the only one I can come up with is the one referring to eating blood (which JW interpret as a condemnation against transfusions). Hmm, mixing ‘foreign’ with native injunctions? (new wine, old wine, not using different cloths, etc??).

Aren’t there really no religious groups that consider vaccins and insurances as a sign one doesn’t trust god? I think that’s the main reason for religious groups in the Netherlands. They don’t object medicine as such, but only things that one would do to prevent things, like vaccins, or to prevent costs, like insurances.

The major religious groups I contacted all have programs promoting vaccination. The general view that seems to be common is that vaccination is a responsibility we all have toward our fellow human beings.

Renate — there are fringe religious groups who regard all medical interventions as a sign of a lack of faith. They usually object to public school as well, though, so this doesn’t generally present a serious problem. None of the mainstream religions forbid vaccination. AFAIK, not even the Jehovah’s Witnesses and Christian Scientists and Scientologists forbid vaccination. You have to be wackier than them to have a religious objection to vaccination.

(Indeed, in this regard, one might recall that part of the reason the Pilgrims wound up over here is that the Dutch church wasn’t strict enough, e.g., allowing baptism without investigating whether the parents were saved.)

Well, we have those in the so-called bible-belt. In places like Staphorst, severel children suffered from polio, because their parents refused vaccination, because their religion opposed it.
Their religion also forbids insurance and they even get an exemption for the health-insurance, which is mandatory overhere. Instead they have to pay some extra taxes, because if they really get very high health expenses, they might need this money.
They don’t object medical interventions, when needed, they just don’t want to show any distrust in god. Everything is in gods hands according to them and if something happens, it’s gods will.
Mostly those people have their own schools, which sometimes gives some weird problems, like a family who needed a school for special needs, but they only found a school which also matched their religion something like 100 km away from their home. To travel to that school, a cab was needed and paid for, because every child has the right to go to school and to a school that is suited.

For vacination those people in the bible-belt are not that bad, because they live in more or less isolated communities. I suppose the people who are in the teachings of Rudolf Steiner, who also are against vaccins, are more of a health danger, because they are mostly well educated and living in cities.

PBE bill in CA hasn’t been signed into law just yet – waiting on Governor Jerry Brown who has until at least Sept 30 to sign or veto. Expecting/hoping for positive outcome but the anti’s have been swarming and seething – sending mail, e-mail, calling and ‘rallying’ at the Capitol.

Thanks for support, tweets and any calls or letters you can send to Governor Brown at CA State Capitol. FAX to the Governor at 916-558-3160

Yeah, the Steiner schools are not good (for a number of reasons). For one thing, since they tend to attract those who oppose immunization, they serve as prime loci for outbreaks; all they’re waiting for is one kid to bring a disease like measles with them.

In a not particularly surprising development, Rob Schneider is due for an “exclusive interview” with Truther Talk. Don’t forget to stop by their online store and pick up a copy of AIDS denialst Liam Scheff’s book.

Monkeys?
It’s hard to see how religion or philosophy justifies a vaccine exemption when it endangers other people’s lives. As a basic ethical matter, I think nonmedical exemptions should be illegal if people are getting the disease being vaccinated against, in any significant numbers.
The courts can’t decide this based on fundamental ethics, they have to base their decisions on things like freedom of religion. But it’s hard to see how someone’s freedom of religion can ever trump someone else’s right to life.
I realize it’s a very delicate matter and it could cause profound feelings of violation, to have the government dictating that something physical be done to one’s body. People’s bodies are where they have a right to choose what goes in. But one’s body also serves as a home and vehicle combined, sort of a RV, for microbes. And the government has a right to control microbe RV’s.
The statistics for vaccinated-against diseases are likely available online from your county health department. In my county, there’s no measles, but there are about 100 cases of whooping cough per year, in a population of about 100,000. Children are probably more likely to get whooping cough, so the odds are worse for them. It seems like enough to get a parent concerned, and something I’ll likely mention the next time a parent brings up vaccines to me.

If vaccines become available for diseases that people often get, it may make people more pro-vaccination. If a vaccine were available for the common cold, for example.
I read that a vaccine for E. Coli urinary tract infections is in the making. It’s a nasal spray – since the infections occur in the mucous membrane of the bladder, apparently the vaccine has to be applied to a mucous membrane, and somehow the immunity is communicated to other mucous membranes. There’s a mucosal immune system that’s separate from the systemic immune system – see for example, http://www.nature.com/nm/journal/v11/n4s/full/nm1213.html
I also read about an experimental sublingual UTI membrane – applied to the mucous membrane under the tongue.
When a UTI vaccine becomes available, it would save a lot of women from a lot of disease. I get sick several times a year from UTI’s, they usually get into my kidneys and they badly interfere with my life. If there were a UTI vaccine, maybe some of the antivaccine moms would change their minds.

I don’t think that vaccines for something like the common cold will make people more pro-vaccination. Those opposed already view some vaccines as unnecessary, thinking that the disease prevented is so mild that any risk of side effects from the vaccine is unacceptable (e.g., they think that chickenpox is a completely benign illness). A common cold vaccine (well, multiple, since there are soooo many things that cause a cold) would just be viewed as money-grubbing on the part of pharmaceutical companies.

@Todd – there was an interesting book I read called “Feed” where a zombie apocalypse is precipitated by the airborne release of the vaccine for the common cold (done my anti-med terrorists, who claimed the vaccine was going to be reserved for only the rich) which combined with a new virus-based Cancer treatment to create a Zombie plague……

Not the greatest example of literature, but definitely a different take on the typical Zombie novel.

The courts can’t decide this based on fundamental ethics, they have to base their decisions on things like freedom of religion.

The First and Fourteenth Amendments only come into the equation if a state introduces a religious exemption in the first place. There is no entitlement whatever to religious privilege where public health is concerned (e.g., Prince v. Massachusetts, 321 U.S. 158 (1944)). The only angle with respect to school requirements is state overreach, which could reasonably be argued for HPV vaccination.

I don’t think that vaccines for something like the common cold will make people more pro-vaccination. Those opposed already view some vaccines as unnecessary, thinking that the disease prevented is so mild that any risk of side effects from the vaccine is unacceptable (e.g., they think that chickenpox is a completely benign illness).

Yes, but colds and UTI’s are common and seriously interfere with people’s lives. I can see people’s reasoning about vaccines, that they can take the chance that their child will get measles or whooping cough, since it’s unlikely to happen.

Wouldn’t forcing a treatment onto a patient without consent constitute an assault?

The state itself can’t really commit “assault” (or, depending on locale, “battery”); its agents can, however, act outside of their authority. The right to refuse treatment itself is not without limits, as a consideration of mental-health codes will illustrate (or, notoriously, Holmes’ opinion in Buck v. Bell; “[t]he principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes.”).

The law itself was only done away with in 1974. I’d say this was shocking, but it was the general time frame when mental-health codes started to be reformed in the U.S., something useful that the antipsychiatry movement may have helped to prompt. (I don’t know whether Rosenhan was affiliated; this work certainly didn’t hurt, either.) The ruling, on the other hand, while widely and properly scorned, hasn’t been explicitly overruled.

I was wondering more about the legal status of the individual practitioner who administers the vaccination.

But to get to the point, it’s been a long time since the U.S. has really seen forcible vaccination. Even the military won’t hold you down. If somebody just sticks a needle into your arm because they feel like it, that’s battery at the very least. So, consider the middle ground: a duly licensed medical professional “slips you a Vicky.” The question whether this is criminal recklessness or civil malpractice can be taken to be whether it represents “an outrage to the State.” (State v. Weiner, 194 A.2d 467 (1963)). Absent a pattern of behavior, treatment without consent has been held to be civil: “Every human being of adult years has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent commits an assault for which he is liable in damages.” (Schloendorff v. Soc’y of the New York Hospital, 105 N.E. 92 (1914).) So, an “assault” in some sense, but not necessarily criminal.

About immunizations…my child left my home in 1985 to reside in an ICF/MR (Intermediate Care Facility for the Mentally Retarded) when he was nine years old. He was required to be up to date with all his immunizations…which he, of course, was.

I accompanied him to most of his pediatric visits and when it was determined that he should have the pneumonia vaccine given to youngsters and adults under age 65 with respiratory or other medical conditions, I signed a consent form

Before my son reached 18, my husband and I went to court to petition to become his legal guardians, my daughter as his substitute legal guardian and a close friend as alternative legal guardian, so that a responsible adult could continue to make decisions about his health care.

I have alternative legal guardianship of my friend’s son who is similarly disabled.

My friend and I who were alternative legal guardians for our “incompetent” sons, have actually made decisions about our sons’ health care….signing permission or giving telephone consent for sedation, LPs, IV contrast materials for CT scans, etc. Each years we signed permission slips for the facility nurses to administer seasonal flu vaccines.

In the instance, where an “incompetent” child or adult has no natural guardian (parent) or responsible adult who has petitioned the court for guardianship once the child reaches age 18, a guardian is appointed by the court…usually an employee (nurse, case manager) employed by the agency that provides residential care.

@ Denice Walter: My buddy and I, with the support of our dear hubbies, moved heaven and earth, to have our boys place in an ICF/MR with around-the-clock-nursing-care. We worked with the Commissioner and the Deputy Commissioner of the NYS OMRDD (Office of Mental Retardation and Developmental Disabilities), to develop a program for our children. The boys were the first children in our County to be placed in an ICF/MR. The only other *option* was a *residential school* in Pennsylvania.

My friend’s son, who was my son’s “roomie” for 18 years, until my son’s death eight years ago, is the young man that I have alternative guardianship of. He’s my “other son” that I visit every Sunday.

Yes, but colds and UTI’s are common and seriously interfere with people’s lives. I can see people’s reasoning about vaccines, that they can take the chance that their child will get measles or whooping cough, since it’s unlikely to happen.

@ Laura, I understand your point however you are applying rational thought to irrational beings. Think of it this way; there is a vaccine that can prevent a certain form of cancer (hep b) and another that may prevent cervical cancers caused by strains contained within the vaccine (hpv vaccines) yet they are the devil incarnate to these people. Add to that the rubella vaccine which can prevent autism and they refuse to acknowledge that benefit as well. Go figure.

Sid, would you like to say anything of relevance to the actual content of the post, or should I just leap to offering you more profitable activities, all of which involve singing “My Old Kentucky Home” and hair removal?

Hi gang, Just came back from a day of working (30 minutes) and drinking (the rest of the day, blame my birthday sunday). It turn out that my recently rebuilt Linux workstation received a request to save a .swf file (adobe flash file) comming from http://cndapi.kaltura.com/.

now this may be a false alert but take care of your computers in any case.

The informed consent can be a sticky wicket. We had our all-county drill this week, and it was an anthrax/mass dispensing scenario. A volunteer roleplayed a drunken and disruptive client and during the hotwash the question arose:

He’s drunk so he can’t give informed consent. Without informed consent, we can’t dispense. But if we don’t dispense, he will probably die (given anthrax’ morbidity and mortality rate). So we’re damned if we do and damned if we don’t.

Think of it this way; there is a vaccine that can prevent a certain form of cancer (hep b) and another that may prevent cervical cancers caused by strains contained within the vaccine (hpv vaccines) yet they are the devil incarnate to these people. Add to that the rubella vaccine which can prevent autism and they refuse to acknowledge that benefit as well.

Actually, it’s not assuming rationality to think that if vaccines help people in an everyday way, not just distant and possible benefits, that it’ll work against the anti-vaxxers.
It isn’t rational to think that if one vaccine helps, they all do.
When enough people stop vaccinating and the vaccinated-against diseases become common, people do start vaccinating more again. So they aren’t totally irrational in that sense. They act in their immediate self-interest more or less.
People generally seek things to demonize, and the anti-vaxxers are an example of that. In other countries, there are other popular demons, like the United States is demonized and Americans are disliked. Here in the United States we feel relatively safe from other countries, so we demonize “environmental toxins”, pesticides, vaccination, and our government and big corporations in general.
Some demons are more likely to harm other people, like the anti-vaxxers, and demonizing certain races.
It may not be possible to stop the tendency to demonize in general, but one CAN make the more dangerous demonizing socially unacceptable. Demonizing some races is very harmful. I think being anti-Semitic was socially acceptable in Nazi Germany, and it permitted to Holocaust. Being racist, anti-Semitic etc. has been successfully made socially unacceptable in the United States.
Here in Ithaca, (Berkeley East) anti-vaccination feelings are tied into the demonizing of government, big corporations etc. People consider anti-vacc attitudes to be a kind of legitimate grassroots social protest against social problems, and they think the ideas of the populace have merit just because they are grassroots protest. Not a rational way to think – I know that popular ideas can be totally wrong – but this is how a lot of people “think”.

MIke Adams has posted his latest article on GMOs ( Natural News, yesterday) where it presides as the jewell in the crown amongst several other GMO fearmongering efforts by his minions:
he reports that only “scientific mercenaries” with “financial ties to Monsanto” and “biotech” still cling to the cherished fiction that GMOs are safe.. when they are, actually, in all Truth..
the SEEDS of DEATH!
this “anti-human technology” is “worse than terrorism” and “even nuclear war”.
You see, a study has illustrated- beyond ALL doubt- that rats develop “horrifying” cancers, thus GMOs will create “an entire generation of cancer victims”.. this “brutality” is an act of “child abuse”.
It is an illustrative instance of “payola science”- science sold to corporations, which is both “fraudulent” and “demonic”. ( note: sounds like vaccines) “Humanity will never be safe until GMO seeds pushers and manufacturers are behind bars”.

MIkey predicts a future where GM seeds in transit to farmers will be “raided and destroyed”- not that he advocates or condones these actions. Then he talks about a film I never saw (“Twelve Monkeys”).

Interestingly enough, Natural News often has ads for ( and has sold) “Heirloom Seeds” and has presented internet radio shows about the horror of GMOs and how necessary organic foods are; a frequent guest is Jeffrey Smith, an anti-GMO activist.

Similar ranting articles ( e.g.Wm Malaurie) show up at Gary Null.com and PRN.

I sometimes think that MIkey and Gary take perverse pleasure in frightening people out of their wits:
imagine that even your FOOD will not be safe to eat, that the air and water are grievously contaminated and that the medical establishment and government are plotting your very destruction, aided and abetted by corporations and their elitist oligarchs ( Bill Gates)

However, a few pure-minded,’spiritual’ scientific altruists are on your side, advising you and providing you the means to escape the rat maze of modern corporate feudalism. Into the light of health and freedom.

I would suspect that they like the power they have over unsuspecting, trusting, frightened people.

Strangely, although I’m not a Christian, I always thought that the ‘truth would set you free’..
not scare you out of your wits and run up your credit card bills for supplements, e-books and natural foods.

Those I survey continuously invoke these fears which I believe may stem from externalising problems to the Other and the enviroment rather than accepting the fact that death and illness are inherent in life.

Parents who write ( @ AoA and TMR) talk about the ‘perfect life’ that was “stolen” from their child.. when in reality, there are no perfect lives and some kids are disabled and others do not do well in school or get serious illnesses or are involved in accidents..

The same intellectual abilities that enable artists to create visions, writers to envision strange, new worlds and scientists to invent improvements in the real one, are the same abilities that can imagine perfection and then get rather upset when it doesn’t roll around and visit you every single day because you’re deserving.

As a Christian, I can’t fathom these people. Despair (at least according to the Catholic Church) is a sin.

It’s too bad but Laura is right. It will take a lot of children falling ill and dying of vaccine-preventable diseases to get their parents to wise up. The two major non-Caucasian ethnic groups in our county are the Indians and the Congolese. They are also the ones first in line at the immunization clinics, because recent history in their parts of the world has taught them that bitter lesson.

Actually, it’s not assuming rationality to think that if vaccines help people in an everyday way, not just distant and possible benefits, that it’ll work against the anti-vaxxers.

Do you read Age of Autism, natural news or Mercola? They denigrate any vaccine for any reason. Malaria? In spite of how many people it would help on a daily basis, they oppose it. Flu vaccines even in light of the risks to children with neurological impairments? Nope. Research into staph vaccines? No there too. These people have painted themselves into such a small corner that they must denigrate any vaccine to maintain their cognitive dissonance and never admit to any benefit.

It may not be possible to stop the tendency to demonize in general, but one CAN make the more dangerous demonizing socially unacceptable.

I agree and we are already seeing the effectiveness of naming and shaming. Anti-vaccinationism is socially unacceptable and those that refuse vaccines are disenfranchised which is why they will normally not discuss it in public. We see anti-vaccine propaganda purveyors caterwauling at being called anti-vaccine and trying to re-brand themselves as “pro-safety vaccine proponents”.

As an atheist, I can despair as much as I like!
But it is a despair tempered by the belief that there has always been opposition to modernity and re-entrenchment in the imagined security of the past. There was even a movement in the early 19th century- Back-to-Nature- leave the city, form new societies, become agrarian.. at least some good poetry came out of it.

There will always be science deniers: I just hope that each new rebellion against reason manages to assimilate a few older innovations as they rebel against the NEWEST ones.
As they say.. we proceed two steps forward, one step back.

Oh, yeah, this was a real production number. The EDNY decision is hilarious: “She was asked why she made an application for an exemption from vaccinations. Her
answer is somewhat difficult for the Court to understand and is set forth at length.” Summary version here.

Take-home lesson for those seeking New York exemptions: Do not cop a crazy attitude if the school officials ask you to come in and explain yourself further, because it’s all downhill from there.

Given that many of the most vociferous anti-vax parents are evidently college-[mis]educated, upper-middle-class types, Loe-Fisher’s invocation of “class warfare” is especially ludicrous.

It’s the Tyranny of the Liberal Arts Majors. I know, because I am one.

We’re the kids who thought we were pretty smart because we could write and even speak in complete sentences, but we suck at math. Because we suck at math, further academic study in the sciences was off-limits to us, along with all the careers that depend on knowing mathematics.

This combination of extreme literacy mixed with extreme innumeracy makes us easy prey for hucksters in the science and economics fields, all the more so because we don’t realize (most of us) just how much we don’t know about so many of the things that make our world function.

Anyone who claims that their health is “in God’s hands” ought to be required to sign a binding DNR (Do Not Resuscitate) order for themselves, before they can even move to the next step in the paperwork game to get a nonmedical exemption for their kid.

But here’s what I’d do about nonmedical exemptions:

Auction them. Higest bidders.

First, ascertain the rate of exemptions that produces a measurable decline in herd immunity. Second, allow half of that number of people in any given municipality or county, to have nonmedical exemptions.

For example if the threshold for herd immunity breakdown is 5% of a population unvaxed, then allow a nonmedical exemption rate of 2.5%. In a county with a population of one million persons, this allows for 25,000 nonmedical exemptions.

Then put the nonmedical exemptions up for auction. Do it on Ebay and require a local zipcode. Let these auctions run for a month, on special arrangement with Ebay (I think Ebay’s max at present is one week).

Then let the bidding begin! If the Tea-Partiers believe in free markets, they’ll have their free market alright!

And if rationalists such as ourselves want to bid for some of those exemptions (just because you win one doesn’t mean you have to use it!), that’s perfectly fair.

The money collected from the auctions, can go to help subsidize health care for poor folks in that county.

I’d love to go to that antivax rally in Sacramento, with a sign saying “Thanks for the Measles! Bring back Smallpox next!”, but my work on Friday can’t be rescheduled (moving a PBX for a doctor’s office).

However I’ll encourage anyone in CA who’s reading this to go if their schedule permits.

One approach that might be interesting is to carry bats#!^-crazy signs such as “9/11: ask me about THE TRUTH!” and “Obama is an illegal space-alien!” and “Natural immunity prevents Smallpox!” and so on. Mix with the crowd and attempt to get your “message” out there. Talk to innocent passers-by and give them the craziest stuff possible.

Also bring flyers! You can do this on your printer easily: make up four small ones to a page, that include some wild anti-vax conspiracy theory (be sure to mention space aliens and Teh Jews!) and Governor Brown’s phone number, email, and postal mail address. Use lots of ALL CAPS or at least Capitalize every third Word to make It seem important Enough. Hand these out to undecideds.

If you don’t want to be photographed looking like a nut, just make yourself look like an even bigger nut: wear a mask, decorated with bright red dots (measles, anyone?) and bristling with antennae above its head (or with a cone-shaped tinfoil hat). (Please no Guy Fawkes masks, that’s a “trademark” of Anonymous, whose street-theatre protests against Scientology put that nasty cult in the news.)

The goal here is to so alarm the undecideds that they call the governor’s office themselves. That and to make sure the local news cameras get plenty of shots of all the “colorfully-costumed” people who showed up to oppose vaccination.

You apparently haven’t gotten the memo that that’s a call for class warfare. And, really, we know that the elites are foisting these poisons upon the sheeple. (Back when I kept an eye on it, there did seem to be a lot of can-WIC-make-me-vaccinate questions. [Answer: no.] I do not state this by way of belittling, but I have wondered whether the simple control aspect–of “information” and action–might be a comfort in such circumstances, not to mention the distraction.)

One approach that might be interesting is to carry bats#!^-crazy signs such as “9/11: ask me about THE TRUTH!” and “Obama is an illegal space-alien!” and “Natural immunity prevents Smallpox!” and so on. Mix with the crowd and attempt to get your “message” out there. Talk to innocent passers-by and give them the craziest stuff possible.

Also bring flyers! You can do this on your printer easily: make up four small ones to a page, that include some wild anti-vax conspiracy theory (be sure to mention space aliens and Teh Jews!) and Governor Brown’s phone number, email, and postal mail address. Use lots of ALL CAPS or at least Capitalize every third Word to make It seem important Enough. Hand these out to undecideds.

While it’s fun to talk about doing something like this (“Vaccination is a tool of Project Monarch! The Monarch Notes prove it!!”) I strongly oppose and urge against any attempt to actually carry it out. For both ethical and practical reasons it’s a bad, bad idea.

The ethical reasons begin, but do not end, with the stark fact that it’s lying to the very people we say we’re trying to reach out to with the truth. We want the undecideds to realize that when they compare what we’re saying about vaccines with what the antivaxxers are saying, we’re the ones whose claims match up with the facts, and they’re the ones whose claims wind up self-contradictory. Why would we surrender the moral high ground by stooping to straw men?

Even if the morality of lying about the antivaxxers’ position was not in the equation, there’s the factor of what happens when the deception is exposed. I’ll be frank; this smells TOO MUCH like “g724” and his “grey ops”, and we all know what happened there. All the antivaxxers have to do is get wind that one person who’s (purportedly) on the pro-vaccination side is proposing such tactics, and they’ll pretend “oh, this is what those Big Pharma vaccine shills do ALL THE TIME! See, this is where one guy says ‘Hey, we should pull this stunt!’ and everyone says ‘Yeah, that’d be awesome!’ except if you look for yourself you can’t see anyone saying that but that’s just because they went back and deleted all those approving comments once they realized they were caught. Also, trust me, there weren’t any posts saying ‘we SHOULDN’T do this’ until after they realized they were caught, then they back-dated those protesting comments.” Again, we have an advantage they can’t match: we don’t need to distort what our opponents say. Why on Earth would we surrender that advantage and turn it into a competition of who can tell more lies about the opposition faster and with less shame? The antivaxxers are posed to win that one, as they’ve been at it all this time.

G2G,
I agree with Antaeus. I think it is much better to combat lies openly, transparently and honestly, using the truth supported by evidence. Even if I agreed with your approach, which I don’t, isn’t putting these kinds of idea on a public blog where everyone can see them kind of dumb? I’m beginning to suspect you are some kind of antivaxxer stooge. Wasn’t the point of changing your ‘nym to leave these kinds of tactics behind? Or perhaps I am mistaking you for someone else.

Why should anyone try to make them look awful when they’re doing a substantially effective job at that already ALL by themselves?

Why should I mis-represent myself? I believe as I do for good reasons and strongly dislike people who mis-represent themselves ( even if it is in the opposite direction- to appear smarter): woo-ville is rife with them.

I thought about attending an anti-vax lecture ( and actually wrote up what I thought I’d encounter- as a joke) and have seen a major woo-meister speak publicly.. it made me want to scream and get up and shake people out of their trance. I’m not an actor to play another person publicly.. I also know my words might influence how others act. What if I asked the woo about how I could help a friend with depression and his advice was taken seriously one of the faithful?

You see, although you may have the best intentions in the world, others may mis-understand what you’re doing ( see the Refusers’ take on G724/ Orac’s re-cap late May); in addition, the wacky views you’d put up are ALREADY known to anti-vaxxers, as are all manner of health freedom,’ GMOs are poisons’ and the’ US and UK are police states” views.. It’s all out there ( both figuratively and literally- see AoA, TMR, Canary Party)

If you truly want to influence on-the-fence folks, why not show your own beliefs? Talk to some attendees calmly and intelligently – and I do think that you are intelligent- tell them why vaccination is a good idea and why you think people are misguided. I’ll bet that you can do it. It would probably help if you are a guy and not small- I’m not being facetious- despite being a slightly taller than average and somewhat athlethic woman – I did not feel very comfortable confronting a crowd of altie groupies in order to question their lord and master in public.
So I held back but managed a snide remark.

Correct you are, lilady. G2G is g724 using a sockpuppet, which means he is now banned. I’m very lenient when it comes to trolling and obnoxious comments, probably so much so that our NatGeo overlords don’t like it. However, the use of sockpuppets is a bannable offense here and always has been. I’m sorry I didn’t notice that G2G is a sockpuppet.

Sockpuppetry aside, it’d be hard to dream up any memes crazier than the ones hardcore antivaxers already promote.

Depopulation schemes, 9/11 nuttiness, a secret military takeover of St. Louis, the virtues of culling the sickly through natural infection, vaccine mind control – these are just a few of the claims promoted in a long-running vaccine thread on another site. You can’t make up stuff this insane.

If memory serves, the last time this banned poster brought up “black ops”, it was triumphantly revealed on an antivax site by a guy who’s proud of having written the song “Vaccine Gestapo”. Relax fellas, no one can match the wounds you already inflict on yourselves.

Anne Dachel is on the move again. She and her sycophants have flooded a blog about the pending New Jersey legislation regarding religious beliefs for opting out of vaccines. I’ve just posted there and could use some support:

Regards my previous comment – I hadn’t read G2G’s comment and was eliding off Sid’s words, rather than anything to do with G2G (and admittedly is partly from having just left a frustrating encounter on a local blog). My apologies if my comment seemed out of step.

Question: Has the California vaccination law been signed by the governor? If not, We should be calling the governor’s office (easy enough for any Californian to do) and ask to be included as a caller in favor of the law. I don’t know how well the rationalist side is doing but if we are not doing it, we should.

Any information on the status of this bill would be appreciated. Thanks.

As much as I tear my hair out at G724/G2G, I have to ask if he is indeed a “sockpuppet” as traditionally defined.

If “G2G” had shown up before, or immediately after G724 departed, and started seconding all G724’s ideas, that would definitely be sockpuppeting, the use of a second account to make ideas look like they have the support of more people than they do.

But as DW pointed out, G724 pretty much told us that “he” would retire the G724 identity and come back under a different persona who would hopefully not cause the controversy G724 had. That’s a course of action that was in fact suggested by one of our regulars to another poster who had caused a big stir with some controversial allegations on gender and violence.

I think we all want everyone to be playing under the same set of rules, and for those rules to be as fair and clear as possible. If others still feel that what G724 has done flouts the rules on sockpuppetry, well, then, I won’t fight it. But it seems to me that if there’s a difference between “retiring an identity” and “sockpuppetry” then G724 falls pretty well on the side of the former.

Antaeus: I really don’t want to begin a discussion about a suggestion I made to a poster here, who has returned to the blog.

I see your point about the timing of the posts (four months apart) and with the tepid apology or nonpology for the black ops posts which were reported by “The Refusers”…as if we condoned the scheme. This latest scheme, while not as devious IMO, was still along the same lines and might have had the same effect of putting Orac in an unfair position, as the blogger and blog moderator.

We have other instances here of people returning intermittently, with a number of different ‘nyms such as the troll from Mississippi and “Sick Sauce” who returned months later after posting under a different (I forgot which), ‘nym.

Then we had the “pothead troll” who posted under a hundred or more ‘nyms during an extended period of time.

Yet, I don’t quite see giving G724 “a pass” by labeling his return here as “retiring an identity”… because of his promise to return here minus the black ops schemes.

[…] that all the parent has to do is to is to sign a piece of paper. This has led to what I call the problem of nonmedical exemptions, which has gotten so bad that states are actually trying to make nonmedical exemptions to vaccine […]

[…] exemptions to school vaccine mandates because religious and philosophical exemptions are too easy to obtain. Boiled down to its essence, AB 2109 would require parents to see a pediatrician or health care […]